Post-Jan. 1 Communication Toolkit: Pharmacy Benefit Manager Transition
On January 1, 2023, CVS Caremark, an independent company, will begin administering pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts. We’ve developed a post-January 1 Pharmacy Benefit Manager (PBM) Communication Toolkit for you to share with your employees.
This toolkit consists of important reminders, which you can send to members via different channels (Slack, SMS, email, postcard, letter, etc.). Here are some of the key things members should know:
- Members should show the pharmacist their new member ID card when filling prescriptions at a retail pharmacy.
- To order 90-day fills through the mail service pharmacy, members will need to create a new account, even if they’ve used mail order before. They’ll be able to provide their billing information, and enroll in auto-refill. They can get started by signing in to their MyBlue account, or calling CVS Customer Care at 1-877-817-0477 (TTY: 711).
- If members have a prescription for a controlled substance, or a medication with no refills, they’ll need to call their doctor to get a new prescription.
- Members can review their medication’s coverage by using our Medication Lookup Tool at bluecrossma.org/medication-2023.
- The best way for members to manage their benefits is to download the MyBlue app, or create an account at bluecrossma.org.
- If members have questions, they can call Team Blue at the Member Service number on their ID card.
We recommend that you should send this communication sometime after January 1, 2023, and before February 15, 2023.
View a PDF version of the post-January 1 PBM Communication Toolkit. If you have any questions, contact your account executive.
Change in Prior Authorization Requirements for Certain Musculoskeletal Services in 2023
We're updating our prior authorization requirements for certain musculoskeletal (MSK) services for all HMO and PPO plan members* to go into effect the second quarter of 2023. We'll review requests according to evidence-based medical necessity criteria to help ensure that members are receiving safe, effective, and medically necessary MSK services. Throughout their MSK treatment, appropriate members will be offered support from our Care Managers.
In- and out-of-network providers will need to submit prior authorization requests for members receiving ongoing treatments for specified joint, spine, and pain management, and for members who begin treatment on or after the effective date.
We’ll provide more information on this upcoming change in the first quarter of 2023. If you have questions, contact your account executive.
* For the full list of services, members should check their plan details or call Member Service.
Helping Blue 20/20 Members Set Their Sights on Eye Exams
Routine eye exams are the best way for members to maintain good eye health. Eye exams can detect health conditions such as diabetes, glaucoma, and cataracts. More than 90% of vision loss caused by diabetes can be prevented through early detection and treatment.1 In November, we launched a vision awareness campaign to educate members about the benefits of routine eye exams and to highlight Blue 20/20’s vision coverage. The campaign included social media posts, a diabetes spotlight on blue2020ma.com, and a member guide focused on eye health and diabetes.
Learn more here. If you have any questions, please contact your account executive.
1. https://www.cdc.gov/diabetes/professional-info/health-care-pro/diabetes-eye-health.html. March 3, 2022.
STOPPING THE FLU STARTS WITH YOU
If your employees haven’t gotten their flu shot yet, now’s the time. It will help protect them and those around them from getting sick, especially young children and older adults who are most at risk. The Centers for Disease Control and Prevention (CDC) says that it’s safe,1 effective, and can be given at the same time as the COVID-19 shot or booster. Encourage your employees to get vaccinated.
Find Help on the Employer Portal
One of the best ways to encourage vaccination is through education. Visit the Employer Portal for informative resources such as fact sheets, brochures, Coverage articles, and FAQs. All are easy to download and share with your employees. Go to Flu Information and Resources under Member Tools and Resources.
The Flu Shot Is Safe1 and Effective, with No Cost2 for Members
The flu vaccine is available to members at no additional cost2 from in-network providers like pharmacies, limited service clinics, and community health centers. Members can also get the vaccine at no additional cost from their doctor if they have an upcoming appointment. To learn more about where and why to get a flu shot, tell members to visit bluecrossma.org/flu.
If you have any questions, contact your account executive.
1. The Centers for Disease Control and Prevention, “Influenza (Flu) Vaccine Safety,” August 25, 2022; cdc.gov/flu/prevent/vaccinesafety.htm.
2. CDC-recommended flu vaccines are covered in full when administered by an in-network provider. Exceptions may apply. Members should check their plan materials for details
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series. These webinars allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts, so you can make the best possible decisions on behalf of your employees. Upcoming topics include:
- Discussion with Sarah Iselin, Our New CEO
- GradFin
- Dental
Presentations last approximately one hour. You can submit your own questions either when you register, or during the webinar. You’ll receive additional details in our monthly webinar emails.
Register for an upcoming webinar. If you have any questions, contact your account executive.
State Legislation’s Impact on Reproductive Health Coverage
With Chapter 127 of the Acts of 2022 signed into Massachusetts state law on July 29, 2022, there are new requirements for how abortion and abortion-related care will be covered by insurance carriers, including Blue Cross Blue Shield of Massachusetts:
- The law, which goes into effect January 1, 2023, mandates coverage for abortion and abortion-related care, without cost sharing for fully insured businesses.
- Fully insured accounts can opt out of this coverage only if they are a church, or church-controlled organization.
- Deductibles will apply to these services for high-deductible health plans (HDHPs), consistent with federal rules for health savings accounts (HSAs).
- The Massachusetts Division of Insurance will issue regulatory guidance to determine what’s included in abortion-related care under the law.
If you have questions, contact your account executive.
Blue Cross Blue Shield of Massachusetts Expedites Access to Care for Members Affected by Tropical Storm Ian
In response to the states of emergency declared in Florida, Georgia, South Carolina, North Carolina, and Virginia in anticipation of Hurricane Ian, Blue Cross Blue Shield of Massachusetts (Blue Cross) is expediting access to care for members who may be impacted.
Blue Cross has more than 187,800 members in the impacted areas along the Southeast coast. We’re working to ensure those members can access health services and medications quickly and in locations convenient to them.
As of September 30, 2022, and for the next 90 days, we’re allowing:
- Early refills of any prescription medication
- Affected members to use Well Connection, the health plan's dedicated telehealth platform, to access medical and mental health services free of cost, with no copayments or deductible with the code BCBSMA126.
(Note: Only members with Blue Cross' telehealth benefit will be able to access Well Connection and only via My Blue)
The Healthy Actions Platform is Being Enhanced
Healthy Actions is an affordable wellness program. Employers can earn back up to 7.5% of their premium, and employees can earn up to $300 in rewards, all while promoting a culture of health and wellbeing.
The updated portal, launched on August 1st, 2022, uses participant data to create a personalized experience that is relevant to their wellness journey and enhanced reporting.
The new platform is enhanced to focus on an intuitive user experience, creating a simple and easy interaction. Enhancements include:
- Mobile-Optimized Approach
- Easy experience to upload forms
- Enhanced participant and customer support
- Real time updates on activities completed
The way the program works will not change, however all current users will need to re-register to create a new log in order to utilize the upgraded platform.
If you have any questions, please or contact your account executive or broker.
New Communication Toolkit: Pharmacy Benefit Manager Transition
Starting January 1, 2023, CVS Caremark, an independent company, will administer pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts. We’ve developed a Pharmacy Benefit Manager (PBM) Communication Toolkit for you to proactively inform your employees about this change.
The toolkit consists of several communications that you can send via different channels (Slack, SMS, email, open enrollment, letter, intranet, etc.). The content conveys the following messages:
- Blue Cross is changing to a new PBM to make pharmacy benefits better
- This change will have little or no effect on most of our members
- Members who are affected will receive additional information from Blue Cross
- Members can sign in to MyBlue to manage their current pharmacy benefit, and go to bcbsma.info/pharmacyupdate after September 13 to learn more about the PBM transition
- On January 1, 2023, pharmacy benefits with the new PBM will go into effect, and members will receive a new ID card before January 1
- Blue Cross will support our members during this change
We recommend that these communications should be sent starting mid-September through November. Note: In November and December, members affected by the change will receive targeted member letters from Blue Cross with clear instructions.
View a pdf version of the PBM Communication Toolkit. If you have any questions, please contact your account executive.
Helping Members with Diabetes Get Recommended Screenings
In September 2022, we’re launching a new, limited-time program with CVS Caremark®´, an independent health solutions company, that helps members with diabetes get recommended screenings and care. This program will support select in-state Commercial and Medicare Advantage members with diabetes, and guide them conveniently to their primary care providers and treating clinicians when appropriate. The program, which is part of our continued efforts to close possible gaps in care, will end in December 2022.
How CVS Caremark Can Help
CVS can:
- Educate members about gaps in care
- Assist members in scheduling appointments with their providers
- Work with us to help members find new, in-network providers, if needed
- Schedule screenings and testing at a CVS HealthHub®´ or MinuteClinic®´, according to the members’ preference
If you have any questions, contact your account executive.
Encompass Fertility™ Has Joined Our Specialty Pharmacy Network for Fertility Medications
Effective July 19, 2022, Encompass Fertility has joined our specialty pharmacy network for fertility medications. They have access to all our covered fertility medications, and they can fill and ship medications in all 50 states.
This change applies to plans with the Blue Cross Blue Shield of Massachusetts formulary, and the National Preferred Formulary (NPF). For more information about specialty fertility medications, use our Medication Lookup tool.
If you have any questions, please contact your account executive.
Making it Easier for Members to Submit Claims
By July 12, 2022, we will roll out online claims submission capabilities for all of our members. This new feature is part of our ongoing efforts to improve our members’ experience with our plans.
With this change, members can now sign in to MyBlue and submit their claims and supporting documentation entirely online. As a result, members will no longer need to print, fill out, and mail in their forms, improving efficiency. Once a claim has been submitted online, we’ll process it and, if approved, the member will receive a check in the mail.
If you have any questions, contact your account executive.
Give Vision Members the Power To Know Before They Go
Effective June 27, 2022, Blue 20/20 is launching a digital tool to help our vision members. The “Know Before You Go” tool is offered by EyeMed®’, an independent company that administers our vision plans. It provides online estimates for members’ out-of-pocket costs, before they meet with their provider. They can get cost estimates for eye exams, frames, lenses, and contact lenses. This way, members avoid cost surprises and get the most from their vision benefits. Members also have the ability to test their vision online with Essilor, an independent ophthalmic optics company, and find out if it’s time to get a more in-depth exam.
Helpful Digital Tools for Blue 20/20 Members
We’ve made it easier than ever for members to take care of their eye health. The “Know Before You Go” tool offers:
- Cost estimates for eye exams, frames, lenses, and contact lenses
- Accessibility on all devices
- Spotlights on special offers
- Quick provider search and ability to schedule appointments online
- Simple definitions and interactive examples of common products
Essilor Vision Test:
- Test vision online to easily know if it’s time for a more detailed exam with a provider
- Seven types of quick, non-diagnostic tests: visual acuity, astigmatism, light sensitivity, near vision 1, near vision 2, color vision, and age-related macular degeneration
Visit www.blue2020ma.com/blue2020ma/en to learn more about these tools. If you have any questions, please contact your account executive.
Metro Drugs Is Leaving Our Specialty Pharmacy Network for Fertility Medications
Effective May 1, 2022, Metro Drugs, a fertility medication pharmacy, will be leaving our specialty pharmacy network. Members will be able to complete their current course of treatment with Metro Drugs, but treatments starting after May 1, 2022 will need to be filled through Freedom Fertility Pharmacy, or Village Fertility Pharmacy in order to be covered. We’ll be contacting affected members about this change, and informing them how to transition to a new pharmacy.
This change applies to plans with the Blue Cross Blue Shield of Massachusetts formulary, and the National Preferred Formulary (NPF). For more information about specialty fertility medications, use our Medication Lookup tool.
If you have any questions, please contact your account executive.
IT’S STILL FLU SEASON. TIME TO GET THEIR SHOT.
It’s never been more important for your employees to get their flu shot. Flu season can last all the way through May, and getting vaccinated will help protect them and everyone around them from getting sick during this crucial time. Your employees can get vaccinated at no additional cost1 at in-network providers, limited service clinics, community health centers, and their doctor’s office. Encourage your employees to get vaccinated today!
Find Help on the Employer Portal
Visit the Flu Information and Resources section on the Employer Portal for educational materials to share with your employees. You’ll find informative resources such as fact sheets, brochures, Coverage articles, and FAQs. All are easy to download and share. Members can also learn more at our Flu Resource Center.
If you have any questions, please contact your account executive.
1. CDC-recommended flu vaccines are covered in full when administered by an in-network provider. Exceptions may apply. Members should check their plan materials for details.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series. These webinars allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts, so you can make the best possible decisions on behalf of your employees. Upcoming topics include:
- The ABC’s of Health Financial Accounts
- CFO Insights: A Financial Update
- Mental Health
- Payment Integrity
Presentations last approximately one hour. You can submit your own questions either when you register, or during the webinar. You’ll receive additional details in our monthly webinar emails.
Register for an upcoming webinar. If you have any questions, please contact your account executive.
Expanding outreach to collect member race, ethnicity, and preferred language information
As part of our ongoing effort to address inequities in health care, we have expanded our race, ethnicity, and language data collection outreach to include a comprehensive mailed survey. This survey is in addition to our existing MyBlue data collection initiative and will serve to engage even more members. Increasing our data collection efforts will allow us to develop a fuller picture of disparities and advance our efforts to address health care equity.
Who will receive the survey?
This mailing will be sent to subscribers in our commercial health plans. Subscribers will be asked to complete the survey for themselves as well as others on their health plan.
When will Blue Cross mail the survey?
From December 2021 to February 2022
How will Blue Cross use the data?
This information will help us work toward our goal of improving the quality and efficiency of care, access to services, and health outcomes for all of our members.
Sharing this information is voluntary. Choosing not to participate will not affect members’ coverage from Blue Cross.
If you have any questions, please contact your account executive.
We’re Decreasing Your Bill Lead-Time
Effective January 2022, Fully Insured accounts (including Stop Loss) will have 10 more days to make changes to your account, since we’ll be generating invoices 15 days prior to their due date, instead of the current 25 days. With this change, not only will we be in line with the industry standard, but you’ll also benefit from:
- Having 10 more days to make enrollment changes and for changes to be reflected on the next invoice
- Having 10 more days for payments to post and be reflected on your next invoice
- An enhanced customer experience, since monthly invoices will include more up-to-date information
Your bill will still be due on the same day each month.
Don’t forget, you can view and pay your premium invoices with our paperless eBilling system. eBilling also lets you:
- Schedule recurring payments
- Create reports on subscriber lists, payments, and outstanding invoices
- Access your payment history 24/7
If you have any questions or would like to be set up on eBilling, please call our Customer Financial Management area at 1-888-751-5607, Monday through Friday from 8:30 a.m. to 4:00 p.m. ET, or email payment.inquiry@bcbsma.com.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series. These webinars allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts, so you can make the best possible decisions on behalf of your employees. Upcoming topics include:
- State Legislative Update
- Federal Legislative Update
- Countdown to 65
Presentations last approximately one hour. You can submit your own questions either when you register, or during the webinar. You’ll receive additional details in our monthly webinar emails.
Register for an upcoming webinar. If you have any questions, please contact your account executive.
Let's Beat Flu. Again!
If your employees haven’t gotten their flu shot yet, now’s the time. It will help protect them and everyone around them from getting sick, especially young children and the elderly, who are the most at risk. All the work that we put in over the last year—record-high flu shots, hand-washing, social distancing, and mask-wearing—really paid off, resulting in the fewest flu cases ever. Let’s keep this going! Encourage your employees to get vaccinated.
Find Help on the Employer Portal
One of the best ways to encourage vaccination is through education. Visit the Employer Portal for informative resources such as fact sheets, brochures, Coverage articles, and FAQs. All are easy to download and share with your employees. Simply go to Flu Information and Resources under Member Tools and Resources.
The Flu Shot Is Safe,1 Effective, and No Cost2 for Members
The flu vaccine is available to members at no additional cost from in-network providers like pharmacies, limited service clinics, and community health centers. Members can also get the vaccine at no additional cost from their doctor if they have an upcoming appointment. To learn more about where and why to get a flu shot, tell members to visit https://www.bluecrossma.org/myblue/your-health/health-and-wellness/flu-resources.
If you have any questions, please contact your account executive.
1. Centers for Disease Control and Prevention (CDC), “Influenza (Flu) Vaccine Safety,” August 26, 2021
2. CDC-recommended flu vaccines are covered in full when administered by an in-network provider. Exceptions may apply. Members should check their plan materials for details.
Making Primary and Mental Health Care More Accessible
As part of our ongoing commitment to creating an unparalleled consumer experience, we're collaborating with innovative providers that offer expanded models of care and simpler, more consumer-focused care delivery. By collaborating with Firefly Health and Brightline, two companies that offer virtual services, we’re increasing member access to convenient and affordable care in Massachusetts. Integrating Firefly Health and Brightline into the MyBlue experience will make it even easier for members to learn about and access these innovative care providers.
Firefly Health
With Firefly Health, an independent health care provider, members in Massachusetts can access primary care through app-based video and chat. Members are assigned an experienced care team led by a doctor, that also includes a nurse practitioner, health guide, and mental health specialist. When members need to be seen in-person, Firefly Health will get them the care they need.
Brightline
Brightline is an independent behavioral health provider that offers a suite of mental health resources tailored for kids, teens, and their families. We recently added Brightline to our provider network. Brightline will be an important part of our ongoing work to expand members’ access to mental health care when mental health needs are rising. For our members residing in Massachusetts, we now cover virtual therapy visits with Brightline’s licensed mental health clinicians.
If you have questions, please contact your broker or account executive.
Improving Care and Quality of Life for Select Members with Chronic Kidney Disease
We’re launching two new programs in early 2022 to improve the care and quality of life for select members diagnosed with chronic kidney disease.
Cricket Health for Fully Insured Commercial Members
We’re partnering with Cricket Health, an independent company that provides personalized kidney care services, to coordinate an extra layer of support for select, fully insured commercial members in Massachusetts diagnosed with chronic kidney disease stage 3b or higher. Cricket Health will help these members learn more about their condition and how to manage its progression, and they’ll support members’ day-to-day needs between medical appointments. Each enrolled member will have a dedicated Cricket Health care team consisting of a nurse, pharmacist, social worker, dietitian, and trained peer mentor they can chat with by phone or online through Cricket Health's digital platform, all at no additional cost.
Square Knot Health for Medicare Advantage Members
We’re partnering with Square Knot Health, an independent company that provides education and mentorship to those with chronic kidney disease, to work with select Medicare Advantage members in Massachusetts whose chronic kidney disease has progressed to stage 4 or higher. Square Knot Health will educate, assess, and mentor enrolled members as they consider treatment options, including transplantation.
Eligible members will be contacted with more details and information on how to get started. If you have any questions, please contact your account executive.
ACS Accounts 500+ Can Now Offer Members Access to Virtual Second Opinions
A second doctor’s opinion can make a big difference when you’re dealing with a serious health concern. That’s why we’re collaborating with 2nd.MD, an independent company that provides members with a virtual second opinion. ASC accounts 500+ can add 2nd.MD for a fee.
Once members enroll in 2nd.MD, they can meet with high-quality medical specialists by video or phone within five days of requesting help. Members receive peace of mind when they need it most, allowing them to make better informed health decisions. Specific benefits include:
- Access to 900 doctors, representing all specialties and subspecialties
- Administrative support from nurses, who collect medical records, schedule appointments, arrange local doctor follow-up care
- Convenient consultations at home or wherever they’re most comfortable
According to 2nd.MD, 60 percent of employers now offer second opinion programs. Employers report savings related to visits for complex—and often costly—conditions, such as cancer and cardiac issues.
If you have any questions, please contact your account executive.
We’re Making Telehealth Services More Accessible
During the COVID-19 pandemic, we expanded access to telehealth services so our members could safely receive medical and mental health care. Effective January 1, 2022, we’re making the following changes* to ensure our members can continue to access the care they need:
- Starting 1/1/2022 Telehealth will be included as a covered method of care delivery.
- Members can choose telehealth visits with their providers when available and appropriate.
- Telehealth visits will cost the same as in-person visits unless specified by your plan (some plans may charge less for a telehealth visit).
Our telehealth platform, Well Connection, which gives members access to confidential, convenient medical and mental health care through a network of highly experienced telehealth providers, will be included for fully insured accounts. ASC accounts can add this benefit for a fee.
If you have any questions, please contact your account executive.
*These changes don’t apply to Medicare Advantage, Federal Employee Program (FEP), and Medex®´ plans.
Sunsetting Identity Protection Services
We’ll be sunsetting our Member Identity Protection Services offered through Experian as of November 2021. Eligible members who sign up by October 31, 2021 can receive one year of services at no-cost.
Three New Personal Spending Account Vendors Offer Choice and Flexibility
We’re excited to announce that we have added three new vendors to our personal spending account portfolio: Fidelity, London Health Administrators, and WEX (formerly Discovery Benefits, Inc.).
We have looked forward to a collaboration with Fidelity for some time, given its enormous brand reputation both locally and nationally, as well as its expertise and steady growth in the HSA space. In fact, Fidelity was recently recognized by Morningstar as the #1 HSA for both spending and investing. We will be offering Fidelity’s HSA for employers with 51 plus full-time equivalents effective 10/1/2021.
Additionally, we are very pleased to add London Health Administrators and WEX (formerly Discovery Benefits, Inc.) to the Market Basket based on the exceptional consumer experience and market capabilities each offers, as well as compelling feedback relayed from many of our broker partners.
The Market Basket
The Market Basket is a group of vendors that support our personal spending account products (health savings accounts, health reimbursement arrangements and flexible spending accounts, among others). The Market Basket vendors are often attractive due to flexibility in their plan designs and related capabilities. While all Market Basket vendors receive a claims file, no eligibility or enrollment integration is available with these partners.
HealthEquity: a fully integrated solution
For a fully integrated personal spending account solution, please continue to keep HealthEquity in mind. HealthEquity includes integration of claims, enrollment, and technology between Blue Cross medical plans and one or more of HealthEquity’s personal spending accounts.
For the client, this integration enables:
- Easy enrollment
- Reduced paperwork, and ultimately
- Access to on-demand reporting through an employer portal
For the member, key advantages include:
- Single sign-on from MyBlue to HealthEquity’s online member portal
- Option to call Blue Cross or HealthEquity for support, with warm transfers between them
- Industry-leading products with several convenient reimbursement options
- Easy access to accounts
- A diverse portfolio of mutual funds for investing health savings account dollars
- An intuitive member platform
Together with our portfolio of vendors and various integration options, our ultimate goal is to offer you easy, world-class solutions to manage employee benefits while helping our members meet their health and financial goals.
HMO Blue Select Network Update
As a result of favorable improvements in the following physician group or hospitals’ cost performance, we are adding them to our limited network, HMO Blue Select. This is effective as a one-day change for all HMO Blue Select plans on July 1, 2021. With this update, members will have now have in-network benefits when receiving services at these providers.
| Physician Groups | Hospitals |
|---|---|
|
|
Questions?
If you have any questions, please contact your account executive.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series. These webinars allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts, so you can make the best possible decisions on behalf of your employees. Upcoming topics include:
- Telehealth Modernization
- Countdown to 65
- Mental Health
- End of Life Care
Presentations last approximately one hour. You can submit your own questions either when you register, or during the webinar. You’ll receive additional details in our monthly webinar emails.
Register for an upcoming webinar. If you have any questions, please contact your account executive.
We’re Expanding Site-of-Care Coverage for Delivery and Maternity Care
On January 1, 2022, we’ll expand our coverage of routine deliveries and maternity care to include standalone birthing centers that aren’t affiliated with or attached to a hospital. Covered services will include maternity care, outpatient delivery, and well newborn care.
To learn more, talk to your account executive.
Blue Cross Blue Shield of Massachusetts Surpassed 2020 Medical Loss Ratio Requirements
In 2020, Blue Cross Blue Shield of Massachusetts exceeded the state and federal medical loss ratio (MLR) requirements for all market segments. As a result, we won’t issue account rebates for 2020.
Each year, the Patient Protection and Affordable Care Act (PPACA) requires insurers to meet certain MLR standards. Insurers who don’t meet these requirements must issue rebates to eligible accounts. We’re proud to have surpassed these requirements for 2020.
We issued voluntary refunds in 2020 as medical service utilization dropped. The MLR rebates calculation is a 3-year average from 2018 to 2020, and the previous years had higher ratios than just the 2020 benefit year.
If you have questions, please contact your account executive, or visit healthcare.gov or mass.gov to learn more about MLR.
Transparency in Coverage Rule and the Consolidated Appropriations Act
Blue Cross continues to actively plan our support of and compliance with the required capabilities for applicable provisions within both the Transparency in Coverage Rule (TCR) and the Consolidated Appropriations Act (CAA). To keep you updated, we created this FAQ document to share important updates on how we will ensure compliance with new requirements. As we wait for further clarification on final regulations, we’ve been taking some actions and assessing what we need to do based on reasonable assumptions. We're providing good faith responses to the best of our ability and reasonable interpretation. It’s important to note that we’ll adjust our approach as we receive further clarification and/or changes to the regulations are made by the Federal Government. We'll continue to make updates to this FAQ document to ensure we keep broker and accounts updated as this work evolves.
State of the Industry: The Path Forward, An Executive Briefing for Blue Cross Partners
On Monday, June 28 from 2:00 p.m. - 3:00 p.m. EST, join Blue Cross Blue Shield Executives for a discussion about the rapid changes in health care, the expected financial implications as we emerge from the pandemic, and our innovation and efforts underway to address costs and improve outcomes for all.
Speakers will include:
- Pat Gilligan, EVP & Chief Commercial Officer
- Andreana Santangelo, EVP & Chief Financial Officer
- Dr. Sandhya Rao, SVP & Chief Medical Officer
- Debbie Williams, SVP & Chief Sales Officer
- Erin Lenox, VP National & Major Accounts
With vaccination rates increasing and government restrictions easing, life is slowly returning to normal. Hear from Blue Cross executives about our outlook on the health care industry and how our efforts are navigating a path forward.
Apply to Have Your Mini-COBRA Premiums Subsidized
Your business may be eligible for a subsidy towards your premium for any former employees and dependents who may be on mini-COBRA from April 1, 2021, through September 30, 2021, under the American Rescue Plan Act of 2021. We’ll cover the cost of these subsidies for eligible accounts. Accounts with 2–19 active employees are eligible for mini-COBRA.
To receive your subsidy, click here to download and complete the attestation form. The attestation form is an editable PDF. Please complete it electronically. If the form is illegible or missing information, it will be returned. Email the completed form to accountservice@bcbsma.com. Please include “Mini-COBRA Attestation Form” in the subject line.
Please note: Subsidy credit will be adjusted monthly and will be reflected in the “Adjustment/Interest” section of your monthly invoice. Some credits may not be posted before the next monthly bill run. Please allow one to two billing cycles for the credit to appear.
Well Connection Is Now Part of MyBlue
We've made it more convenient for members to get the care they need. As of June 10, 2021, members simply need to sign in to their MyBlue account to use Well Connection for their medical or mental health needs. Well Connection offers members convenient access to medical care 24/7, and mental health care by appointment. Integrating Well Connection into the MyBlue experience makes it even easier for members to have video doctor visits with licensed providers, therapists, and psychiatrists.
After June 10, the Well Connection website and app will no longer be available.
Important Employer Surveys: Medical Loss Ratios and Employer Group Size
In July, fully insured Blue Cross Blue Shield of Massachusetts accounts will receive one or both of the following surveys in the mail:
- The Patient Protection and Affordable Care Act (PPACA) survey, which allows us to calculate medical loss ratios (MLR) accurately for the small- and large-employer group segments. If MLR standards aren't met, we'll issue premium rebates to the applicable employers.
- The federal Medicare Secondary Payer (MSP) survey, which allows us to annually track an account's total number of employees. This will help us determine whether Medicare or an employer group health plan pays for an employee's health claims first, based on MSP laws.
It's important that you respond as soon as possible. These surveys help determine the size of each of our accounts, so we can calculate our medical loss ratio, establish which accounts are eligible to receive a rebate in 2022, and ensure that your employees' claims are processed properly.
Which Survey(s) You’ll Receive
| Account Type | Survey(s) |
|---|---|
| Fully insured accounts | |
| Accounts that canceled coverage with Blue Cross in 2020 | The PPACA survey |
Questions?
If you have any questions, please contact your account executive. For more information about these surveys, medical loss ratios, or MSP rules, please see:
PPACA Frequently Asked Questions
MSP Frequently Asked Questions
Changes to Telehealth Benefit
Effective July 1, 2021, we'll reinstate member cost share for non-COVID-19 covered services provided via telehealth, including care provided telephonically and via video chat. We're also expanding the types of services eligible for telehealth coverage. Details of these changes are below.
Cost Share for Non-COVID Telehealth Services Resumes
Last year, because of pandemic-driven shutdowns, Blue Cross temporarily waived cost share for non-COVID telehealth services to maintain member access to health care and to help prevent infection and illness. As vaccines roll out and states and businesses reopen, this cost-share waiver for non-COVID services will end on July 1, 2021. Standard cost share for non-COVID telehealth services will apply.
We'll continue to waive member cost share for COVID-19 related telehealth services. We'll also continue to waive member cost share for in-person, COVID-19 related services when performed in an outpatient setting. Cost share is waived for inpatient COVID-19 services for both fully insured and ASC accounts that have opted in.
Telehealth Benefits Expanded
The coronavirus pandemic illustrated how vitally important telehealth is as a method of providing medical and behavioral health care for patients and caregivers. Hundreds of thousands of our members have successfully received remote care. With the growing popularity of telehealth and the benefit it provides, we're expanding the types of care available via telehealth to better meet the needs of our members and help our provider partners better serve their patients.
In line with the Patients First Act signed by Massachusetts Governor Baker effective January 1, 2021, providers can deliver any medically necessary services covered under a member's health plan via telehealth (including telephonic and video chat) when appropriate. Blue Cross had already temporarily allowed this in response to COVID-19, and we're now making it a permanent change. For these expanded telehealth services, member cost share will be the same as if the services were performed in-person.
Questions?
If you have additional questions, please reach out to your account executive. Thank you for your continued partnership.
Dental Blue® and Blue 20/20 Member ID Cards Are on MyBlue
We’ve added Dental Blue and Blue 20/20 digital ID cards to MyBlue as part of our ongoing efforts to improve our members’ experience. This new feature shows all of their ID cards on MyBlue via the Web and app, offering greater access to the tools and resources our members need.
Members can:
- Conveniently access their digital ID cards for our medical, dental, and vision plans, all in one place
- View and download their ID cards and share copies via email
- Use click-to-call to contact Member Service directly from their device
Questions?
If you have any questions, please contact your account executive.
See Our Electronic Enrollment Reminders
We’re committed to making the health care experience easier for all of our members and partners. That’s why we’ve created an electronic enrollment fact sheet that will help answer common questions that might come up while submitting your eligibility files.
This fact sheet covers:
- Potential termination reports
- Social Security Number updates
- Retroactive transactions
- Underwriting approval for disabled dependents and adoption
- Gender
- Updating your contact information
You can see the Electronic Enrollment Reminders Fact Sheet here. Please keep it on hand for easy reference.
Questions?
If you have any questions, please contact your account executive.
Monthly Settlement Statements Issue
Blue Cross Blue Shield of Massachusetts experienced a technical issue on March 22 as we migrated to a new email application for our billing system. As a result, a small number of ASC customers and trusted business partners, such as brokers, received multiple emails that included monthly settlement statements for other ASC accounts.
This was a technical malfunction and not a data breach. No personal information, personal health information, individual claims detail or other individual level confidential information related to customers, brokers or members was exposed. Information that may have been seen by unintended recipients was aggregate claims data, account monthly payments made and amount or credit due.
The issue was identified within ten minutes of sending the emails and immediate steps were taken to stop the process and recall the invoices. Ninety-five percent of emails were never opened. Since then, Blue Cross has taken action to identify and remedy the root cause of this issue and put in place secondary controls to further reduce the possibility of a similar incident in the future.
If you have any questions, please reach out to your Account Executive.
1099-HC Tax Form Is Now Available on MyBlue
Subscribers can now view, download, and print their 1099-HC tax form for their 2020 taxes through MyBlue.* After signing in to MyBlue, they need to click on My Inbox and then My Documents. In the My Documents folder, they’ll see their 1099-HC tax form for tax years 2019 and 2020. Or, they can click here to access their tax forms directly.
Only the plan subscriber can access their 1099-HC tax form through MyBlue. However, the form includes information on their dependent(s) along with the month(s) covered. The 2019 form is only available to those who were subscribed during that year.
We’ll be communicating this update to subscribers in February 2021 through an SMS message, website content, Facebook posts, and email.
If you have any questions, please contact your account executive.
*Subscribers will also receive their 2020 form by mail.
Streamlined Authorization Management Tool for Providers
We recently launched the next phase of a tool called Authorization Manager, which allows providers to manage their authorizations and referrals for all of our members. Providers can use the tool to submit and view the status of all of their authorization requests, and to view the status of their referral submissions.
Now, more than ever, it’s important that we offer our providers digital tools that support both them and our members. This online tool is available 24/7, from the office or when working remotely, and gives providers easier access to the member information they need.
The tool, offered through MHK, an independent company, builds on the authorization management system we launched in February 2020 for our Medicare Advantage members. The system has been expanded to include commercial, indemnity, Federal Employee Program, and Medex®´ plans.
You don’t need to take any action as a result of this change.
New Cost-Share Assistance Program Can Save Self-Insured Accounts and Their Members Money on Eligible Brand-Name Specialty Medications
Self-insured accounts and their members can see savings on eligible brand-name specialty medications,* when accounts add the Cost-Share Assistance Program to their pharmacy benefit. We recently partnered with PillarRx Consulting, an independent company, to administer this program for self-insured accounts with pharmacy coverage. Accounts can add the program at renewal at no additional cost.
Value to Accounts
On average, our book-of-business savings may range from $5 to $7 PMPM after risk share.** Actual savings can vary and will depend on members’ specific utilization of eligible medications. Accounts can request an estimate of their savings from their account executive.
How it Works
The Cost-Share Assistance Program uses coupons from manufacturers of medication to cover most or all of a member’s out-of-pocket costs for eligible medications. The program applies these coupons when a member fills a prescription, reducing their out-of-pocket cost to anywhere between $0 and $35, depending on the specific medication.
How Members Enroll
PillarRx®´ reaches out to members who are taking an eligible medication, based on claims data, and helps them enroll over the phone. Enrollment is optional; however, members who don’t enroll will have higher out-of-pocket costs, and accounts won’t realize the cost savings.
Account and Member Support
We chose to partner with PillarRx because it’s an industry leader in pharmacy benefit programs like the Cost-Share Assistance Program that offers accounts seamless program administration. The PillarRx Care Team also provides members with enrollment education and assistance, and ongoing, high-touch support.
Questions?
If you have any questions, please contact your account executive.
*For the current list of eligible medications, contact your account executive.
**Savings are not guaranteed and will vary by account.
Well Connection Is Coming to MyBlue
Coming soon: Well Connection will be integrated into MyBlue. Members will be able to simply sign in to their MyBlue account to use Well Connection for their medical and mental health needs. This change streamlines the member experience by eliminating the need to download multiple apps, and create separate accounts.
Well Connection offers members convenient access to medical care 24/7, and mental health care by appointment. Integrating Well Connection into the MyBlue experience will make it even easier for members to have video visits with licensed providers, therapists, and psychiatrists.
Employees Should Make a Plan to Get Their Flu Shot
Flu season can last through the end of May. And with COVID-19, it’s more important than ever for your employees to get their flu shot. It will keep them, their family, and community from getting sick during this crucial time. They can get their flu shot at no additional cost* from in-network providers like pharmacies, limited service clinics, and their doctor if they have an upcoming appointment.
Employees should follow these steps, so they can plan out the easiest and safest way to get vaccinated:
- Find a location near them using vaccinefinder.org
- Verify the location is in their network by signing in to MyBlue and visiting Find a Doctor & Estimate Costs.
- Make an appointment ahead of time, if possible. If not, they can ask if there are slower times during the week.
For more information, talk to your account executive, or visit https://www.bluecrossma.org/myblue/your-health/health-and-wellness/flu-resources.
*CDC-recommended flu vaccines are covered in full when administered by an in-network provider. Exceptions may apply. Members can check plan their materials for details.
Go Paperless Campaign Launching in February 2021
We’re launching a Go Paperless campaign, targeting members who have a medical, dental, or Medex®´ plan, and haven’t already selected a communication preference. This does not apply to Medicare Advantage members. Starting in February 2021, these members will receive a postcard and email (for those members that have provided an email) saying that they’ll no longer receive claim summary statements (Summary of Health Plan Payments, Explanation of Benefits, and Dental Predetermination of Benefits) in the mail unless they take action. They’ll be prompted to:
- Sign in to MyBlue, and go to Communication Preferences.
- Choose email or text if they want to go paperless, and receive a notification when they have a statement ready to view on MyBlue.
- Choose paper if they want to continue receiving their statements in the mail.
If members don’t select a preference, they’ll receive a postcard in the mail when they have a statement to view on MyBlue.
If you have any questions, please contact your account executive.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series. These webinars allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts, so you can make the best possible decisions on behalf of your employees. Spring 2021 topics include:
- Plan Sponsor Manual and Eligibility Requirements
- Care/Case Management
- Planning for Medicare – Countdown to 65
- Total Benefits Solutions – Life Sciences
Presentations last approximately one hour. You can submit your own questions either when you register, or during the webinar.
Register for an upcoming webinar. If you have any questions, please contact your account executive.